<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('User_box_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-user_box_id" data-rule="required" data-source="user/box/index" class="form-control selectpage form-control" name="row[user_box_id]" type="text" value="{$row.user_box_id}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Damage_amount')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-damage_amount" data-rule="required" class="form-control form-control" step="0.01" name="row[damage_amount]" type="number" value="{$row.damage_amount}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Damage_level')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-damage_level" class="form-control form-control" name="row[damage_level]" type="text" value="{$row.damage_level}">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-success btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
